,Saunders NCLEX-RN® Blueprint: Chapter
wise Q&A with Concise Rationales
Table of Contents
📘 NCLEX-RN® Preparation – Table of Contents
Unit & Chapter Title
UNIT I: NCLEX-RN®
Preparation
Clinical Judgment and the NCLEX-RN®
Chapter 1
Examination
– The Pyramid to Success
– The Examination Process
– Computer Adaptive Testing
– Development of the Test Plan
– The Test Plan
– Types of Questions and Scoring
– Registration and Authorization to
Test
– Changing Your Appointment
,Unit & Chapter Title
– Day of Examination & Testing
Accommodations
– Testing Center & NGN Test Design
– Pass-or-Fail Decisions & Results
– Candidate Performance Report
– Nurse Licensure Compact &
International Nurse
Chapter 2 Self-Efficacy and Profiles to Success
– Pyramid to Success
– Increasing Self-Efficacy
– Developing Control
– Building Confidence
The NCLEX-RN® Examination: A
Chapter 3
Graduate’s Perspective
– NGN Reflections by Madison Drew
Mahon, BSN, RN
Clinical Judgment and Test-Taking
Chapter 4
Strategies
,| UNIT II: Client Needs | |
| Chapter 5 | Client Needs and the NCLEX-RN® Test Plan |
| | – Physiological Integrity |
| | – Safe and Effective Care Environment |
| | – Health Promotion and Maintenance |
| | – Psychosocial Integrity |
| Chapter 6 | Physiological Integrity Practice Questions |
| Chapter 7 | Safe and Effective Care Environment Practice
Questions |
| Chapter 8 | Health Promotion and Maintenance Practice
Questions |
| Chapter 9 | Psychosocial Integrity Practice Questions |
| UNIT III: Integrated Processes | |
| Chapter 10 | Integrated Processes and the NCLEX-RN® Test
Plan |
| | – Caring |
| | – Clinical Judgment |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Nursing Process |
| | – Teaching and Learning |
| Chapter 11 | Integrated Processes Practice Questions |
| | – Caring |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Teaching and Learning |
| | – Nursing Process: Assessment |
,| | – Nursing Process: Analysis |
| | – Nursing Process: Planning |
| | – Nursing Process: Implementation |
| | – Nursing Process: Evaluation |
,Chapter 1: Clinical Judgment and the NCLEX-RN® Examination
(Saunders Q&A Review, 9th Ed., 2025).
1. The Pyramid to Success
Question 1 A nursing student is reviewing the Pyramid to
Success model for clinical judgment. Which level of the pyramid
emphasizes choosing appropriate interventions based on data
analysis?
A. Total Client Need
B. Clinical Skills and Clinical Reasoning
C. Application and Outcomes
D. Assessment and Data Collection
Answer: C. Application and Outcomes
Rationale:
Correct (C): The top of the Pyramid to Success focuses on
applying analyzed data to select nursing interventions and
evaluating outcomes.
Option A: Total Client Need is the broad category of
needs, not a pyramid level.
Option B: Clinical Skills and Clinical Reasoning correspond
to mid-levels but focus on skills and thought processes
rather than action.
, Option D: Assessment and Data Collection represent the
base of the pyramid, focusing on gathering raw data rather
than intervention.
Question 2 The foundation of the Pyramid to Success model is:
A. Critical thinking skills
B. Data collection through assessment
C. Evaluation of client outcomes
D. Nursing interventions
Answer: B. Data collection through assessment
Rationale:
Correct (B): The base level emphasizes accurate
assessment to gather relevant client data.
Option A: Critical thinking is integrated throughout but not
the foundation.
Option C: Evaluation is at the top, reflecting outcomes
after interventions.
Option D: Interventions occur after analysis, not at the
foundation.
2. The Examination Process
,Question 3 Which statement best describes the primary goal of
the NCLEX-RN® examination process?
A. To rank nursing candidates nationally
B. To measure minimal competency for safe practice
C. To assess theoretical knowledge only
D. To evaluate educational program effectiveness
Answer: B. To measure minimal competency for safe practice
Rationale:
Correct (B): The NCLEX-RN® ensures each candidate meets
the minimum competency for safe, entry-level nursing
practice.
Option A: The exam is criterion-referenced, not norm-
referenced.
Option C: It assesses application and judgment, not just
theory.
Option D: Although used indirectly for program
evaluation, its primary focus is individual competency.
Question 4 During test registration, candidates receive
authorization to test (ATT). ATT is valid for:
A. 30 days
B. 60 days
,C. 90 days
D. 120 days
Answer: C. 90 days
Rationale:
Correct (C): The Authorization to Test is valid for 90 days
for exam scheduling.
Option A/B/D: These durations are incorrect; only 90 days
is accurate.
3. Computer Adaptive Testing (CAT)
Question 5 In Computer Adaptive Testing (CAT), if a candidate
answers an item correctly, the next question will be:
A. Easier
B. Harder
C. Of equal difficulty
D. The same content area
Answer: B. Harder
Rationale:
Correct (B): Correct responses lead CAT algorithms to
present more challenging items to pinpoint ability level.
Option A: Incorrect; CAT increases difficulty after correct
answers.
, Option C: Difficulty adjusts dynamically.
Option D: Content area varies according to test plan, not
solely content.
Question 6 The CAT algorithm terminates when:
A. The candidate misses 3 consecutive questions
B. Maximum time expires
C. Confidence interval around ability estimate meets criterion
D. The candidate completes 150 questions
Answer: C. Confidence interval around ability estimate meets
criterion
Rationale:
Correct (C): CAT ends when statistical confidence in the
measurement of ability is reached.
Option A: Consecutive misses do not automatically end
the exam.
Option B: There is no time limit beyond scheduling
windows.
Option D: 145 is the maximum, but early termination
occurs when confidence criteria are met.
4. Development of the Test Plan
wise Q&A with Concise Rationales
Table of Contents
📘 NCLEX-RN® Preparation – Table of Contents
Unit & Chapter Title
UNIT I: NCLEX-RN®
Preparation
Clinical Judgment and the NCLEX-RN®
Chapter 1
Examination
– The Pyramid to Success
– The Examination Process
– Computer Adaptive Testing
– Development of the Test Plan
– The Test Plan
– Types of Questions and Scoring
– Registration and Authorization to
Test
– Changing Your Appointment
,Unit & Chapter Title
– Day of Examination & Testing
Accommodations
– Testing Center & NGN Test Design
– Pass-or-Fail Decisions & Results
– Candidate Performance Report
– Nurse Licensure Compact &
International Nurse
Chapter 2 Self-Efficacy and Profiles to Success
– Pyramid to Success
– Increasing Self-Efficacy
– Developing Control
– Building Confidence
The NCLEX-RN® Examination: A
Chapter 3
Graduate’s Perspective
– NGN Reflections by Madison Drew
Mahon, BSN, RN
Clinical Judgment and Test-Taking
Chapter 4
Strategies
,| UNIT II: Client Needs | |
| Chapter 5 | Client Needs and the NCLEX-RN® Test Plan |
| | – Physiological Integrity |
| | – Safe and Effective Care Environment |
| | – Health Promotion and Maintenance |
| | – Psychosocial Integrity |
| Chapter 6 | Physiological Integrity Practice Questions |
| Chapter 7 | Safe and Effective Care Environment Practice
Questions |
| Chapter 8 | Health Promotion and Maintenance Practice
Questions |
| Chapter 9 | Psychosocial Integrity Practice Questions |
| UNIT III: Integrated Processes | |
| Chapter 10 | Integrated Processes and the NCLEX-RN® Test
Plan |
| | – Caring |
| | – Clinical Judgment |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Nursing Process |
| | – Teaching and Learning |
| Chapter 11 | Integrated Processes Practice Questions |
| | – Caring |
| | – Communication and Documentation |
| | – Culture and Spirituality |
| | – Teaching and Learning |
| | – Nursing Process: Assessment |
,| | – Nursing Process: Analysis |
| | – Nursing Process: Planning |
| | – Nursing Process: Implementation |
| | – Nursing Process: Evaluation |
,Chapter 1: Clinical Judgment and the NCLEX-RN® Examination
(Saunders Q&A Review, 9th Ed., 2025).
1. The Pyramid to Success
Question 1 A nursing student is reviewing the Pyramid to
Success model for clinical judgment. Which level of the pyramid
emphasizes choosing appropriate interventions based on data
analysis?
A. Total Client Need
B. Clinical Skills and Clinical Reasoning
C. Application and Outcomes
D. Assessment and Data Collection
Answer: C. Application and Outcomes
Rationale:
Correct (C): The top of the Pyramid to Success focuses on
applying analyzed data to select nursing interventions and
evaluating outcomes.
Option A: Total Client Need is the broad category of
needs, not a pyramid level.
Option B: Clinical Skills and Clinical Reasoning correspond
to mid-levels but focus on skills and thought processes
rather than action.
, Option D: Assessment and Data Collection represent the
base of the pyramid, focusing on gathering raw data rather
than intervention.
Question 2 The foundation of the Pyramid to Success model is:
A. Critical thinking skills
B. Data collection through assessment
C. Evaluation of client outcomes
D. Nursing interventions
Answer: B. Data collection through assessment
Rationale:
Correct (B): The base level emphasizes accurate
assessment to gather relevant client data.
Option A: Critical thinking is integrated throughout but not
the foundation.
Option C: Evaluation is at the top, reflecting outcomes
after interventions.
Option D: Interventions occur after analysis, not at the
foundation.
2. The Examination Process
,Question 3 Which statement best describes the primary goal of
the NCLEX-RN® examination process?
A. To rank nursing candidates nationally
B. To measure minimal competency for safe practice
C. To assess theoretical knowledge only
D. To evaluate educational program effectiveness
Answer: B. To measure minimal competency for safe practice
Rationale:
Correct (B): The NCLEX-RN® ensures each candidate meets
the minimum competency for safe, entry-level nursing
practice.
Option A: The exam is criterion-referenced, not norm-
referenced.
Option C: It assesses application and judgment, not just
theory.
Option D: Although used indirectly for program
evaluation, its primary focus is individual competency.
Question 4 During test registration, candidates receive
authorization to test (ATT). ATT is valid for:
A. 30 days
B. 60 days
,C. 90 days
D. 120 days
Answer: C. 90 days
Rationale:
Correct (C): The Authorization to Test is valid for 90 days
for exam scheduling.
Option A/B/D: These durations are incorrect; only 90 days
is accurate.
3. Computer Adaptive Testing (CAT)
Question 5 In Computer Adaptive Testing (CAT), if a candidate
answers an item correctly, the next question will be:
A. Easier
B. Harder
C. Of equal difficulty
D. The same content area
Answer: B. Harder
Rationale:
Correct (B): Correct responses lead CAT algorithms to
present more challenging items to pinpoint ability level.
Option A: Incorrect; CAT increases difficulty after correct
answers.
, Option C: Difficulty adjusts dynamically.
Option D: Content area varies according to test plan, not
solely content.
Question 6 The CAT algorithm terminates when:
A. The candidate misses 3 consecutive questions
B. Maximum time expires
C. Confidence interval around ability estimate meets criterion
D. The candidate completes 150 questions
Answer: C. Confidence interval around ability estimate meets
criterion
Rationale:
Correct (C): CAT ends when statistical confidence in the
measurement of ability is reached.
Option A: Consecutive misses do not automatically end
the exam.
Option B: There is no time limit beyond scheduling
windows.
Option D: 145 is the maximum, but early termination
occurs when confidence criteria are met.
4. Development of the Test Plan
